The public may never know how a suicidal 20-year-old was able to hang himself under a hospital’s psychiatric care, or what steps the hospital is taking to ensure it doesn’t happen again, because of a “deeply-flawed piece of legislation” with little or no apparent oversight.

The 2004 Act was meant to encourage health professionals to speak openly about medical error without fear and to protect patient privacy, but in reality it “enables hospitals to hide information from families,” said Natalie Mehra, executive director of the Ontario Health Coalition.

“There’s a real public interest” in how people with mental health issues are cared for, she said, since “many may have suicidal family members or they themselves may be suicidal.”

According to the act, QCIPA trumps the Freedom of Information and Protection of Privacy Act and supersedes all other acts unless its own regulations “specifically provide otherwise.”

That means that when a hospital investigation — such as that into Tiwari’s suicide — is put under the Act, everything from experts’ opinions to the final report, including any recommended changes to care, could be withheld from the public for privacy reasons.

The problem is, QCIPA is interpreted differently by different people.

“I’ve maybe seen one or two occasions where it actually works properly,” Paul Harte, a medical malpractice lawyer, said of the Act.

But many health care professionals and patient advocates, including Tom Closson, the former head of the Ontario Hospital Association, criticized Humber CEO Rueben Devlin for misinterpreting the Act.

“There is nothing under (the Act) that says he can’t tell everybody what he is doing to improve the situation so something like that doesn’t happen again,” Closson said at the time.

The Brampton hospital is not saying how it interprets the Act, which means the public may never find out what steps they plan to take to avoid another suicide.

Adding to the confusion is uncertainty over who exactly oversees the use of QCIPA.

The Ministry of Health and Long-Term Care “does not have an administrative, supervisory or adjudicative role with respect to the implementation,” said a spokesperson, who was unable to answer questions about who has oversight.

The Information and Privacy Commissioner of Ontario handles appeals under the Act, but says it has no oversight.

“The general rule is: once Quality of Care, always Quality of Care,” said interim Privacy Commissioner Brian Beamish. That means that if the hospital designates an investigation under QCIPA, the public won’t find out how and why something happened.

Patients and families have to appeal or sue to attempt to get the information. If successful, they could share it with the public.

The health coalition fields calls from at least three people every month regarding QCIPA, Mehra says, but many “don’t have the time or resources to jump through all the hoops,” meaning the investigation usually remains secret.

Since Prashant hanged himself, the Coroner’s Office, which is also investigating, has answered some of the family’s questions, but even the coroner’s access is limited under QCIPA.

“We can’t have access to the content of those discussions or even summon someone to an inquest and give evidence about the details of what they found,” said Dr. William Lucas, interim deputy chief coroner. “What we can get from them is basically their conclusions as to, say, systemic issues that they identified and what their action plan would be.”

At the time of the hospital investigation into the wrongly declared dead baby last year, Deputy Health Minister Dr. Bob Bell, then president and CEO of University Health Network, acknowledged “there’s a lot of misunderstanding about what’s protected in QCIPA.” But whether a change in health minister means an opportunity to clarify the legislation remains unclear. Neither Bell nor Minister Eric Hoskins were available for interviews.

Tiwari says he intends to keep fighting for answers.

Answers, both for his family and for the public, are necessary, he says. “It’s time something should be done.”

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